Limp

Limp

Leah Harrington

Introduction

Common presentation to emergency department
May be difficult to localize source of pain (e.g., hip pain may be referred to knee)
Young children often not able to localize pain

Table 41.1 Motor Development Milestones

10-12 mo	Cruising: walks holding onto stationary objects for support
12-18 mo	Walks independently
36 mo	Mature walking pattern

Table 41.2 Common Abnormal Gaits

Antalgic	Shortened stance phase gait associated with pain (e.g., septic hip, transient synovitis, fracture)
Trendelenburg	Side lurching gait, trunk shifts toward and pelvis tilts away from painful or weak extremity, decreasing force transmitted through extremity (e.g., congenital hip dislocation, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis)

History

Age: diagnosis by age groups—see Table 41.3
Onset of pain: sudden vs insidious
Duration of pain: intermittent vs constant
Quality of pain: severe vs mild
Location of pain: reproducible/localizable, referred pain common
History of trauma: accidental vs nonaccidental
- Often not witnessed
- Does trauma mechanism match development abilities?
Constitutional symptoms: fever, weight loss, night sweats, malaise (neoplasms and rheumatologic infections)

Physical Examination

Table 41.3 Differential Diagnoses by Age

BIRTH-2 YEARS	2-10 YEARS	10-18 YEARS
Septic arthritis	Septic arthritis	Fractures
Toddler’s fracture (spiral fracture of tibia in ambulating child)	Transient synovitis	Slipped capital femoral Epiphysis (SCFE)
Osteomyelitis	Osteomyelitis	Osteomyelitis
Congenital hip dislocation	Legg-Calvé-Perthes	Patellofemoral problems
Nonaccidental trauma	Juvenile idiopathic arthritis	Tumors
	Leukemia	Sickle cell crisis
	Fractures
	Sickle cell crisis

Table 41.4 Differential Diagnoses: Systems Approach

INFECTIOUS	MUSCULOSKELETAL	INFLAMMATORY	HEMATOLOGICAL	NEUROMUSCULAR
Osteomyelitis	Child abuse	JRA	Sickle cell crisis	Guillain-Barré
Septic arthritis	SCFE	Myositis	Hemophilia	Tick paralysis
Cellulitis	CHD	Transient synovitis	Leukemia
Discitis	Fractures
Abscess	Neoplasms
CNS infections
Appendicitis
Epididymitis

Specific Conditions

Transient Synovitis

Jun 22, 2016 | Posted by drzezo in EMERGENCY MEDICINE | Comments Off

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